Related Terms

• Brewer's yeast, Florastor®, Florastor® Kids, Hansen CBS 5926, Lactobacillus, Lactobacillus acidophilus, Lactobacillus bulgaricus, Lactobacillus gasseri, Lactobacillus GG, Lactobacillus plantarum, Perenterol®, probiotic, S. boulardii, Saccharomyces cerevisiae, Saccharomyces salivarius, Saccharomyces thermophilus, Saccharomycetaceae (family), Ultra-Levure®, yeast.

• Note: There is debate as to whether Saccharomyces boulardii is a subspecies of Saccharomyces cerevisiae or a separate entity. Traditional techniques cannot distinguish the two, but manufacturers of Saccharomyces boulardii claim that the two yeasts are separate species.

Background

• Saccharomyces boulardii is a non-pathogenic yeast strain that has been used for treatment and prevention of diarrhea. Saccharomyces boulardii is classified as a "probiotic," or a microorganism that when ingested may have a positive influence on the host's health. Probiotics may exert their effects on the gastrointestinal system directly, or may modulate the immune system in a larger scope.

• Human studies indicate Saccharomyces boulardii may prevent antibiotic-associated diarrhea, Clostridium difficile diarrhea in combination with antibiotic therapy, diarrhea associated with tube feeds, and acute childhood diarrhea. Promising initial studies have shown that Saccharomyces boulardii may be beneficial in treating diarrhea associated with HIV.

• The German Commission E has approved the use of Saccharomyces boulardii for symptomatic treatment of acute diarrhea, prophylactic and symptomatic treatment of diarrhea during travel, treatment of diarrhea occurring while tube feeding, use as an adjuvant for chronic acne, for a dietary supplementation, and for a source of B vitamins and protein.

Scientific Evidence

Tradition/Theory

The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious and should be evaluated by a qualified health care professional.

• Acne, aging, allergies, anorexia, autism, cancer, Candidal infection, cholera, colitis (inflamed colon), constipation, cystic fibrosis, depression, diabetes, digestive disorders (Hirschsprung's disease), fatigue, fever, flatulence (gas), food allergies, H. pylori infection (children), herpes, hyperlipidemia (high cholesterol), lactose intolerance, mood changes (irritability), nutrition, osteoporosis (prevention), premenstrual syndrome (pms), seborrheic dermatitis (inflamed skin), skin disorders, stress, ulcerative colitis, ulcers, urinary tract infections (UTIs), weight loss.

Dosing

The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

Adults (18 years and older):

• In large multicenter trials, few (if any) side effects have been noted in patients taking Saccharomyces boulardii for up to 15 months. Regardless of diarrhea type, Saccharomyces boulardii is often taken in doses of 500-2,000 milligrams in divided daily doses (three or four times daily). The brand name product, Ultra-Levure®, has been studied in doses of 2-4 capsules daily for up to eight months. For antibiotic-associated diarrhea, 1 gram daily for three days following completion of antibiotics has been used. Two sachets per day containing 5x109 colony forming units (CFU) per sachet has also been used for four weeks. One capsule twice daily has been used; duration was not noted. 250-500mg twice daily for up to two weeks following antibiotics has been used. Four capsules Ultra-Levure® daily for eight months has been used.

Children (younger than 18 years):

• The most commonly used dose for Saccharomyces boulardii in children for the treatment of diarrhea is 250-600 milligrams daily for up to five days. This has been given alone and in combination with antibiotics.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

• Avoid in individuals with a known allergy or hypersensitivity to yeast, Saccharomyces boulardii, Saccharomyces cerevisiae, or other species in the Saccharomycetaceae family. Saccharomyces boulardii use may be associated with itching, urticaria ("hives"), and generalized skin eruptions.

Side Effects and Warnings

• Saccharomyces boulardii has been generally well tolerated in human studies for treatment of various diarrheal disorders. Symptoms of Saccharomyces cerevisiae infection included septic shock in more than one patient and fever in another. Symptoms of sepsis (infection) included increased white blood cell count, abdominal meteorism (swelling from gas), and respiratory insufficiency. In general, contamination occurred in patients with an indwelling vascular catheter.

• Constipation, increased thirst, flatulence (gas), and bloating have been associated with Saccharomyces boulardii use. Use cautiously in patients with constipation.

• Saccharomyces boulardii fungemia (fungal infection) has occurred. Avoid in patients with a yeast infection. Symptoms included septic shock in more than one patient and fever in another. Symptoms of sepsis include white blood cell count increase, abdominal meteorism, and respiratory insufficiency. In general, contamination occurred in patients with an indwelling vascular catheter.

• Saccharomyces boulardii use may also cause Quincke's edema (swelling) or increases or decreases in blood pressure when used with MAOIs.

Pregnancy and Breastfeeding

• Saccharomyces boulardii is not recommended in pregnant or breastfeeding women due to a lack of available scientific evidence.

Interactions

Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.

Interactions with Drugs

• Concomitant antibiotic treatment may change gastrointestinal flora, subsequently increasing steady state levels of Saccharomyces boulardii in humans. According to various clinical trials, use of Saccharomyces boulardii in combination with antibiotics decreases the frequency and duration of diarrhea. Caution is also advised when taking Saccharomyces boulardii with other antidiarrheal agents due to additive effects.

• Use of antifungal agents may result in decreased efficacy of Saccharomyces boulardii.

• Use of metronidazole plus iodoquinol plus Saccharomyces boulardii was more effective than metronidazole plus iodoquinol alone for reducing diarrhea associated with amebiasis (intestinal infection). Similarly, use of mesalamine plus Saccharomyces boulardii may be more effective than mesalamine alone for reducing diarrhea associated with Crohn's disease. These may be examples of positive interactions.

• Saccharomyces boulardii taken in combination with monoamine oxidase inhibitors (MAOIs) may lower blood pressure.

Interactions with Herbs and Dietary Supplements

• Concomitant antibiotic treatment with herbs or supplements may change gastrointestinal flora, subsequently increasing steady state levels of Saccharomyces boulardii in humans. According to various clinical trials, use of Saccharomyces boulardii in combination with antibiotics decreases the frequency and duration of diarrhea.

• Caution is also advised when taking Saccharomyces boulardii with other antidiarrheal herbs or supplements due to additive effects.

• Use of antifungal herbs or supplements may result in decreased efficacy of Saccharomyces boulardii.

• Saccharomyces boulardii taken in combination with herbs or supplements with monoamine oxidase inhibitor-like activity may lower blood pressure.

Author Information

• This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

References

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

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